Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania
Identifieur interne : 002B66 ( Pmc/Curation ); précédent : 002B65; suivant : 002B67Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania
Auteurs : Inga Kirsten [Allemagne] ; Julius Sewangi [Tanzanie] ; Andrea Kunz [Allemagne] ; Festo Dugange [Tanzanie] ; Judith Ziske [Allemagne] ; Brigitte Jordan-Harder [Allemagne] ; Gundel Harms [Allemagne] ; Stefanie Theuring [Allemagne]Source :
- PLoS ONE [ 1932-6203 ] ; 2011.
Abstract
Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania.
A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002), 4.4 (P = 0.015) and 7.8 (P = 0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004). In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold.
Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis.
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DOI: 10.1371/journal.pone.0021020
PubMed: 21695214
PubMed Central: 3112206
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wicri:step="Curation">002B66</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania</title><author><name sortKey="Kirsten, Inga" sort="Kirsten, Inga" uniqKey="Kirsten I" first="Inga" last="Kirsten">Inga Kirsten</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Sewangi, Julius" sort="Sewangi, Julius" uniqKey="Sewangi J" first="Julius" last="Sewangi">Julius Sewangi</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Regional AIDS Control Program Mbeya Region, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania</addr-line></nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Regional AIDS Control Program Mbeya Region, Ministry of Health and Social Welfare, Dar es Salaam</wicri:regionArea></affiliation></author><author><name sortKey="Kunz, Andrea" sort="Kunz, Andrea" uniqKey="Kunz A" first="Andrea" last="Kunz">Andrea Kunz</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Dugange, Festo" sort="Dugange, Festo" uniqKey="Dugange F" first="Festo" last="Dugange">Festo Dugange</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Kyela District Hospital, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania</addr-line></nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Kyela District Hospital, Ministry of Health and Social Welfare, Dar es Salaam</wicri:regionArea></affiliation></author><author><name sortKey="Ziske, Judith" sort="Ziske, Judith" uniqKey="Ziske J" first="Judith" last="Ziske">Judith Ziske</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Jordan Harder, Brigitte" sort="Jordan Harder, Brigitte" uniqKey="Jordan Harder B" first="Brigitte" last="Jordan-Harder">Brigitte Jordan-Harder</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Harms, Gundel" sort="Harms, Gundel" uniqKey="Harms G" first="Gundel" last="Harms">Gundel Harms</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Theuring, Stefanie" sort="Theuring, Stefanie" uniqKey="Theuring S" first="Stefanie" last="Theuring">Stefanie Theuring</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania.</p></sec><sec><title>Methods and Findings</title><p>A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002), 4.4 (P = 0.015) and 7.8 (P = 0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004). In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold.</p></sec><sec><title>Conclusions</title><p>Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="De Cock, Km" uniqKey="De Cock K">KM De Cock</name></author><author><name sortKey="Fowler, Mg" uniqKey="Fowler M">MG Fowler</name></author><author><name sortKey="Mercier, E" uniqKey="Mercier E">E Mercier</name></author><author><name sortKey="De Vincenzi, I" uniqKey="De Vincenzi I">I de Vincenzi</name></author><author><name sortKey="Saba, J" uniqKey="Saba J">J Saba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Guay, La" uniqKey="Guay L">LA Guay</name></author><author><name sortKey="Musoke, P" uniqKey="Musoke P">P Musoke</name></author><author><name sortKey="Fleming, T" uniqKey="Fleming T">T Fleming</name></author><author><name sortKey="Bagenda, D" uniqKey="Bagenda D">D 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21695214</article-id><article-id pub-id-type="pmc">3112206</article-id><article-id pub-id-type="publisher-id">PONE-D-10-06131</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0021020</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Clinical Research Design</subject><subj-group><subject>Observational Studies</subject></subj-group></subj-group><subj-group><subject>Global Health</subject></subj-group><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Viral Diseases</subject><subj-group><subject>HIV</subject><subj-group><subject>HIV epidemiology</subject><subject>HIV prevention</subject></subj-group></subj-group></subj-group></subj-group><subj-group><subject>Obstetrics and Gynecology</subject><subj-group><subject>Genitourinary Infections</subject><subj-group><subject>HIV</subject></subj-group></subj-group><subj-group><subject>Pregnancy</subject><subj-group><subject>Pregnancy Complications</subject></subj-group></subj-group><subj-group><subject>Postpartum Care</subject></subj-group></subj-group><subj-group><subject>Pediatrics</subject><subj-group><subject>Neonatalology</subject></subj-group></subj-group><subj-group><subject>Public Health</subject><subj-group><subject>Preventive Medicine</subject></subj-group></subj-group><subj-group><subject>Urology</subject><subj-group><subject>Genitourinary Infections</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group><subj-group><subject>Women's Health</subject></subj-group></subj-group></article-categories><title-group><article-title>Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania</article-title><alt-title alt-title-type="running-head">Adherence to PMTCT Combination Regimen</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kirsten</surname><given-names>Inga</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sewangi</surname><given-names>Julius</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kunz</surname><given-names>Andrea</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Dugange</surname><given-names>Festo</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ziske</surname><given-names>Judith</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jordan-Harder</surname><given-names>Brigitte</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Harms</surname><given-names>Gundel</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Theuring</surname><given-names>Stefanie</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Regional AIDS Control Program Mbeya Region, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Kyela District Hospital, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Myer</surname><given-names>Landon</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">University of Cape Town, South Africa</aff><author-notes><corresp id="cor1">* E-mail: <email>stefanie.theuring@charite.de</email></corresp><fn fn-type="con"><p>Conceived and designed the experiments: IK JS AK FD JZ BJ-H GH ST. Performed the experiments: IK JS FD JZ. Analyzed the data: IK JS AK ST GH. Contributed reagents/materials/analysis tools: IK AK JS FD BJ-H. Wrote the paper: IK JS AK GH ST. Revision of masuscript for intellectual content: IK JS AK FD JZ BJ-H GH ST. Final approval: IK JS AK FD JZ BJ-H GH ST.</p></fn></author-notes><pub-date pub-type="collection"><year>2011</year></pub-date><pub-date pub-type="epub"><day>10</day><month>6</month><year>2011</year></pub-date><volume>6</volume><issue>6</issue><elocation-id>e21020</elocation-id><history><date date-type="received"><day>6</day><month>12</month><year>2010</year></date><date date-type="accepted"><day>18</day><month>5</month><year>2011</year></date></history><permissions><copyright-statement>Kirsten et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</copyright-statement><copyright-year>2011</copyright-year></permissions><abstract><sec><title>Background</title><p>Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania.</p></sec><sec><title>Methods and Findings</title><p>A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002), 4.4 (P = 0.015) and 7.8 (P = 0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004). In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold.</p></sec><sec><title>Conclusions</title><p>Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis.</p></sec></abstract><counts><page-count count="9"></page-count></counts></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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